Anyone suffering from fibromyalgia will tell you it can be devastating. On some days, simple chores like doing laundry or making breakfast can be exhausting, if not downright impossible. According to the National Institutes of Health, more than 5 million Americans — mostly women — have fibromyalgia. What Causes Fibromyalgia? Woman having knee pain in medical office While the cause of fibromyalgia is widely debated, Dr. Ethan Russo, a prominent neurologist and pharmacologist who has dedicated much of his professional career studying cannabis and the endocannabinoid system, theorized that fibromyalgia could be related to Clinical Endocannabinoid Deficiency (CECD). The endocannabinoid system is like the Internet of your body — a communications network facilitating communications between your brain, organs, connective tissues, glands, and immune cells. The primary goal of the ECS is homeostasis — helping your body maintain a stable internal environment. When the endocannabinoid system is out of whack, health suffers. An imbalance can cause a whole host of issues affecting mood, sleep, gastrointestinal health, muscle spasticity, to name a few — symptoms that are also prominent among sufferers of fibromyalgia, thusly supporting Russo’s theory. Can Medical Marijuana be Used as Treatment for Fibromyalgia? Hard to treat and impossible to cure, many sufferers are curious about whether cannabis can help treat their discomfort. Robnett, who is also the founder and executive director of Colorado-based Cannabis Patients Alliance, was one such patient. Recalling how in 1987 a car accident triggered her fibromyalgia, she later learned that an endocannabinoid deficiency could be to blame. She fell to the floor and cried, but her sadness was swiftly replaced with anger. Recognizing cannabis might be able to help, she asked, “How could the one thing that could supplement what my body wasn’t making [is something] the government could tell me I can’t have?” For years Robnett took doctor-prescribed pharmaceuticals, but she detested the side effects and was concerned about drug interactions. “In 2009, I started medical marijuana. By 2011, I had quit all of my pharmaceutical medications and now use cannabis exclusively,” she explained. Robnett said that at first, it took her a bit of trial-and-error, but it didn’t take long for her to become convinced cannabis was preferable to pharmaceuticals. “From season to season, even day to day, the severity of symptoms can change because of the weather, stress, or hormones,” Robnett said. “Cannabis allows me to self-titrate. By being able to vary how I consume and types of strains, I can more effectively treat the symptoms.” At night, Robnett medicates with an edible. Because edibles can take a bit to kick in, she begins her routine by vaporizing with an indica strain which quickly enters the bloodstream and immediately provides relief. While vaporizing works quickly, it doesn’t last through the night. “The edible takes much longer to affect me than vaporizing but lasts much longer, and I can sleep through the night,” she said. “Getting a good night’s sleep helps keep my symptoms under control the next day.” During the day, she’ll use something higher in CBD and lower in THC to minimize psychoactive effects while alleviating her symptoms. Chronic fatigue is also a common symptom, and Robnett said the high CBD counters the fatigue, giving her energy to get through the day. Cannabis for Treating Fibromyalgia vs. Prescription Drugs Colorful tablets with capsules and pills on blue background Robnett is not alone in her experience. The National Pain Foundation conducted a survey in 2014 of over 1,300 patients. Remarkably, nearly a third — 30 percent of respondents — reported having used medical cannabis. Of the more than 390 survey participants who had used cannabis, compared to FDA-approved pharmaceuticals, far more people reported cannabis as being effective: 62% reported cannabis as “very effective” in treating their symptoms 33% reported that cannabis “helped a little” Only 5% said it did not help at all Contrast these results with FDA-approved medications: A mere 8 – 10% reported Cymbalta, Lyrica, or Savella as “very effective” 60 – 68% responded those drugs “[did] not help at all” No wonder “big pharma” is scared of cannabis! In the hierarchy of evidence, a survey is not weighted the same as a random-controlled trial (RCT). However, given the relative safety profile of cannabis and absence of adverse side effects compared to the FDA-approved medications, the data clearly suggests more research is warranted. Synthetic Cannabinoids for Fibromyalgia There has been just one double-blind, placebo-controlled randomized, controlled trial (RCT) of synthetic cannabinoids. Researchers concluded nabilone was a “beneficial, well-tolerated treatment option” that could be a viable adjunct to other therapies. But, anecdotally, patients report they prefer botanical cannabis. Only 10% to 20% of the THC makes its way into the bloodstream after metabolizing. Furthermore, nabilone doesn’t come cheap! 30 capsules cost more than $1,000. Robnett is happy with cannabis. “With cannabis, I can vary by strain and consumption method according to how I feel or what time of day it is. More importantly, over the 28 years, I’ve suffered from this condition, I found cannabis is by far the most effective and efficient treatment.” Given the widespread frustration patients have with available treatments, and the devastating nature of fibromyalgia on those who live under its grip, it’s hard to find a morally defensible reason to deprive patients like Robnett the right to not only alleviate their suffering but find a new lease on life.

Can Marijuana Help AIDS/HIV Patients?

Centers for Disease Control (CDC) stated on Oct. 20, 2006 postings on its website titled “What Is AIDS?” and “What Is HIV?”: “AIDS stands for Acquired Immunodeficiency Syndrome. Acquired – means that the disease is not hereditary but develops after birth from contact with a disease-causing agent (in this case, HIV). Immunodeficiency – means that the disease is characterized by a weakening of the immune system. Syndrome – refers to a group of symptoms that collectively indicate or characterize a disease. In the case of AIDS, this can include the development of certain infections and/or cancers, as well as a decrease in the number of certain cells in a person’s immune system. HIV (human immunodeficiency virus) is the virus that causes AIDS. This virus may be passed from one person to another when infected blood, semen, or vaginal secretions come in contact with an uninfected person’s broken skin or mucous membranes. In addition, infected pregnant women can pass HIV to their baby during pregnancy or delivery, as well as through breastfeeding. People with HIV have what is called HIV infection. Some of these people will develop AIDS as a result of their HIV infection.” Oct. 20, 2006 – Centers For Disease Control (CDC) ________________________________________ PRO (yes) The Institute of Medicine concluded in its Mar. 1999 report titled “Marijuana and Medicine: Assessing the Science Base”: “The profile of cannabinoid drug effects suggest that they are promising for treating wasting syndrome in AIDS patients. Nausea, appetite loss, pain, and anxiety are all afflictions of wasting, and all can be mitigated by marijuana. Although some medications are more effective than marijuana for these problems, they are not equally effective in all patients. A rapid-onset (that is, acting within minutes) delivery system should be developed and tested in such patients. Smoking marijuana is not recommended. The long-term harm caused by smoking marijuana makes it a poor drug delivery system, particularly for patients with chronic illnesses.” Mar. 1999 – Institute of Medicine “Marijuana and Medicine: Assessing the Science Base” (988 KB) The American Academy of HIV Medicine (AAHIVM) stated on Oct. 8, 2007, Reason Magazine: “When appropriately prescribed and monitored, marijuana/cannabis can provide immeasurable benefits for the health and well-being of our patients.” Oct. 8, 2007 – American Academy of HIV Medicine Kate Scannell, MD, Co-Director of the Kaiser-Permanente Northern California Ethics Department, in a Feb. 16, 2003 article published in the San Francisco Chronicle wrote: “From working with AIDS and cancer patients, I repeatedly saw how marijuana could ameliorate a patient’s debilitating fatigue, restore appetite, diminish pain, remedy nausea, cure vomiting and curtail down-to-the-bone weight loss.” Feb. 16, 2003 – Kate Scannell, MD Margaret Haney, Ph.D., Associate Professor of Clinical Neuroscience at Columbia University, et. al, in their Aug. 15, 2007 study titled “Dronabinol and Marijuana in HIV-Positive Marijuana Smokers: Caloric Intake, Mood, and Sleep,” published in the Journal of Acquired Immune Deficiency Syndromes, stated: “As compared with placebo, marijuana, and dronabinol [a synthetic pill form of THC] dose-dependently increased daily caloric intake and body weight in HIV-positive marijuana smokers… Effects of marijuana and dronabinol were comparable, except that only marijuana (3.9% THC) improved ratings of sleep. Conclusions: These data suggest that for HIV-positive marijuana smokers, both dronabinol (at doses 8 times current recommendations) and marijuana were well tolerated and produced substantial and comparable increases in food intake.” Aug. 15, 2007 – Margaret Haney, PhD Donald I. Abrams, MD, Professor of Clinical Medicine at the University of California at San Francisco, et al., wrote on Feb. 13, 2007, article titled “Cannabis in Painful HIV-Associated Sensory Neuropathy: A Randomized Placebo-Controlled Trial” in the journal Neurology: “Objective: To determine the effect of smoked cannabis on the neuropathic pain of HIV-associated sensory neuropathy, and an experimental pain model… Patients were randomly assigned to smoke either cannabis (3.56% thc) or identical placebo cigarettes with the cannabinoids extracted three times daily for 5 days… Conclusion: Smoked cannabis was well tolerated and effectively relieved chronic neuropathic pain from HIV-associated sensory neuropathy. The findings are comparable to oral drugs used for chronic neuropathic pain.” Feb. 13, 2007 – Donald Abrams, MD Consumer Reports Magazine stated in May 1997: “Consumer Reports believes that, for patients with advanced AIDS and terminal cancer, the apparent benefits some derive from smoking marijuana outweigh any substantiated or even suspected risks.” May 1997 – Consumer Reports Magazine CON (no) The U.S. Drug Enforcement Agency (DEA) stated in a Jan. 2, 2002 email to ProCon.org: “Marijuana can affect the immune system by impairing the ability of T-cells to fight off infections, demonstrating that marijuana can do more harm than good in people with already compromised immune systems.” Jan. 2, 2002 – US Drug Enforcement Administration (DEA) The Institute of Medicine concluded in its Mar. 1999 report titled “Marijuana and Medicine: Assessing the Science Base”: “The relationship between marijuana smoking and the natural course of AIDS is of particular concern because HIV patients are the largest group who report using marijuana for medical purposes. Marijuana use has been linked both to increased risk of progression to AIDS in HIV-seropositive patients and to increased mortality in AIDS patients. The most compelling concerns regarding marijuana smoking in HIV/AIDS patients are the possible effects of marijuana on immunity. Reports of opportunistic fungal and bacterial pneumonia in AIDS patients who used marijuana suggest that marijuana smoking either suppresses the immune system or exposes patients to an added burden of pathogens. In summary, patients with pre-existing immune deficits due to AIDS should be expected to be vulnerable to serious harm caused by smoking marijuana. The relative contribution of marijuana smoke versus THC or other cannabinoids is not known.” Mar. 1999 – Institute of Medicine “Marijuana and Medicine: Assessing the Science Base” Mark L. Kraus, MD, Former President of the Connecticut Chapter of the American Society of Addiction Medicine, in his testimony to the Judiciary Committee in Hartford Connecticut on Feb. 26, 2007, stated: “Marijuana smoked, like tobacco smoked, contains toxins and other foreign particulates that are known to cause inflammation in the lining of the lungs. Unlike tobacco smoke, marijuana smoke substantially reduced the alveolar macrophages, the lung’s primary defense against infectious microorganisms, foreign substances, and tumor cells. This is of particular concern for the immunocompromised HIV/ AIDS patients or cancer patient, who is already at great risk for opportunistic lung infections. Though the evidence is no means conclusive, chronic marijuana smoking may be a factor in the development of acute and chronic bronchitis, and increasing the risk of pneumonia.” Feb. 26, 2007 – Mark L. Kraus, MD Janet Lapey, MD, Executive Director of Concerned Citizens for Drug Prevention, Inc., in her Oct. 1, 1997 Statement to the Subcommittee on Crime of the Committee on the Judiciary in the House of Representatives: “Marijuana is not the safe drug portrayed by the marijuana lobby. It is addictive; it adversely affects the immune system… Marijuana use is a risk factor for the progression to full-blown AIDS in HIV-positive persons, and HIV-positive marijuana smokers have an increased incidence of bacterial pneumonia.” Oct. 1, 1997 – Janet Lapey, MD Michael D. Roth, MD, and Donald P. Tashkin, MD, Professors of Medicine at the David Geffen School of Medicine at UCLA, et. al, in their Aug. 19, 2005 study titled “Tetrahydrocannabinol Suppresses Immune Function and Enhances HIV Replication in the HuPBL-SCID Mouse,” published in Life Sciences, wrote: “Marijuana smoking has been reported to predispose to bacterial pneumonia, opportunistic infections and Kaposi’s sarcoma in HIV-positive individuals, as well as to a more rapid progression from HIV infection to AIDS… [Our] results suggest a dynamic interaction between THC, immunity, and the pathogenesis [development of] of HIV. They also support epidemiologic studies that have identified marijuana use as a risk factor for HIV infection and the progression of AIDS.” Aug. 19, 2005 – Michael D. Roth, MD

Can Marijuana Help Anxiety?

Relief from anxiety is one of the most commonly cited reasons for using marijuana. What’s more, scientists are starting to uncover evidence that marijuana may be a highly effective treatment for anxiety disorders. The use of cannabis for treating anxiety was first described in 1563 when Portuguese physician Garcia de Orta claimed that cannabis could deliver sufferers from “all worries and care.” The effects of marijuana have been described as calming, relaxing and even hypnotic. Many long-time users of marijuana report that the drug reduces their anxiety, citing relaxation and stress relief as the main benefits. In addition to anecdotal evidence, there is some science to back up what many users claim. An 2014 study from Vanderbilt University found that smoking marijuana can increase the presence of naturally-occurring brain chemicals called endocannabinoids, which are reduced as a result of chronic stress. Some researchers think that a reduction of endocannabinoids could be a major cause of anxiety disorders. Marijuana may also be more safe and effective than traditional anxiety medications. A recent Canadian study found that within 90 days of using prescribed medical cannabis for anxiety and pain, 40% of patients were able to stop using benzodiazepines — a commonly prescribed anxiety drug with a number of side effects, including a high potential for abuse. Studies also suggest that marijuana could be an effective treatment for PTSD. Since marijuana is known to play a direct role in memory extinction, some experts believe that it could help PTSD sufferers forget bad memories and negative experiences.

Can Medical Cannabis Be Used as an Anorexia Treatment?

A characteristic feature of cannabis is that it causes the “munchies,” which begs the question: could cannabis be used to treat anorexia nervosa? Cannabis has been widely studied as a treatment for anorexia (or cachexia) associated with cancer and HIV/AIDS. However, there’s little research on whether it would be an effective treatment to treat the type of anorexia that most people are familiar with: anorexia nervosa. It’s unfortunate so little research has been done given how many people are affected and what the consequences are of leaving anorexia untreated. According to the National Eating Disorders Association (NEDA), 20 million women and 10 million men will develop an eating disorder at some point in their lives, with anorexia being one of the most common disorders. Among college students, the numbers are even more staggering: the National Institute of Mental Health estimates 25% of college students suffer from an eating disorder. Left untreated, the consequences can be dire. Anorexia has the highest mortality rate (12.8 percent) of any psychiatric disease. A shocking 6 percent commit suicide. What is Anorexia Nervosa? According to NEDA, anorexia nervosa is “a serious, potentially life-threatening eating disorder characterized by self-starvation and excessive weight loss.” Extremely low body weight, body dysmorphia (a distorted perception in body image), an obsession with counting calories, and an excessive need to control one’s environment are all common among sufferers. Individuals also often base their sense of self-worth on their body weight and shape and have difficulty finding pleasure in activities that most people consider enjoyable. What Are the Causes of Anorexia? Historically, the causes of anorexia have been attributed to sociocultural factors such as childhood trauma or family members’ (and society’s) attitudes towards the desirability of thinness and slimness. However, evidence has emerged in recent years that also underscores the role of genetics and neurobiological factors. Can Medical Marijuana Treat Anorexia? The idea that cannabis could help treat anorexia seems like a no-brainer. After all, not only is cannabis notorious for inducing the “munchies,” but research on cannabis as an appetite stimulant for those suffering from cancer or HIV/AIDS has validated cannabis’s effectiveness. However, when it comes to anorexia nervosa, we only have a few studies. Only a handful of states consider anorexia a qualifying condition for medical cannabis, but many include related issues like uncontrolled weight loss, anxiety, and nausea. Nonetheless, given the research we have accumulated, anecdotal evidence and the fact the endocannabinoid system — the body’s own cannabinoid system — exerts such a powerful influence on appetite, cannabis as an anorexia treatment is highly plausible. A 2011 Belgian study suggests that because dysfunctional regulation and underlying imbalances within the endocannabinoid system are prominent across eating disorders, developing cannabinoid-derived treatments (targeting the endocannabinoid system) could prove therapeutically valuable. The study offers promise that cannabinoids could help correct endocannabinoid deficiencies while helping the individual return to a healthy state. However, this was a small study, and clearly, more research is warranted. In 2014, European neuroscientists conducted an important animal study offering another possible explanation on why cannabis (or specifically THC) may be useful in treating anorexia. Anorexia sufferers lose the ability to find pleasure in activities, particularly eating. And, authors of the study found that the way THC activates the endocannabinoid system’s CB1 receptor (one of two identified receptors) elevates pleasure in eating by increasing our sensitivity to smells and taste. A human study hailing from the Center for Eating Disorders at Odense University Hospital in Denmark provided encouraging data (although, with just 24 subjects, the study was fairly small). In this study, patients were given a placebo or dronabinol (a synthetic form of THC). On average, patients gained 1.6 lbs more on dronabinol than the placebo. The authors noted the treatment was “well tolerated” with “few adverse events.” Further, researchers followed up with patients a year after starting treatment and determined patients were still improving their symptoms and nutrition while showing no signs of addiction or withdrawal issues. Mainstream is Still Not Convinced The mainstream medical community, however, has thus far remained unconvinced. According to Tamara Pryor, director of clinical research at the Eating Disorder Center of Denver, individuals suffering from anorexia are empowered by not succumbing to the temptation of eating, so “stimulating their appetite can’t necessarily overcome the neurobiological issues that are also intimately involved with their disorder.” That being said, Pryor notes, “Marijuana may be a helpful tool for some people — in conjunction with therapy.” By therapy, she’s referring to cognitive behavioral therapy (CBT), which is accepted as one of the most effective forms of treatment. Likewise, more often than not, anorexia accompanies other psychiatric disorders, particularly anxiety-related disorders. While cannabis may be helpful in treating comorbid conditions, could a patient’s perceived relief from other symptoms (e.g. insomnia or anxiety) increase the risk that they develop a dependency disorder? On the other hand, could strains high in non-psychoactive CBD(which has no reinforcing, habit-forming properties) provide relief, while reducing dependency risk? While mainstream medicine may not yet be convinced, unsurprisingly, there is no shortage of people who credit cannabis with helping them overcome anorexia. A clinical cannabis patient from Los Angeles, Sarah (who for confidentiality reasons declined to use her real name), told Leafly that for years she struggled with anorexia. Doctors gave her antidepressants and anti-anxiety drugs, which she says helped her with some of her issues, but did nothing to help her kick anorexia to the curb. “I tried for years to overcome anorexia and bulimia. For me, anorexia was a way to fulfill my need for control over my life. I was never much of a pot user, but recalling how [cannabis] gives you the munchies, I decided to give it a shot,” says Sarah. “It worked remarkably well. I became less self-conscious, I lost my obsession with counting calories, and I started enjoying food again.” Sarah claims cannabis provided a “short-term solution to a long-term problem.” She claims that within six months she beat anorexia. She now consumes only occasionally. “I haven’t totally gotten over my body issues, and that most often becomes an issue during intimacy with my fiancé. So now I’ll occasionally medicate and I’ve found that I’m far less self-conscious and it brings us closer.” While cannabis may provide a valuable alternative treatment for anorexia, cannabis should not be seen as a panacea. It may serve a role, but given the seriousness of the condition (including the high mortality rates), consulting a specialist and enlisting support through peer groups is vital. Two organizations, National Eating Disorders Association (NEDA) and National Association of Anorexia Nervosa and Associated Disorders (ANAD), provide valuable online resources to individuals or loved ones impacted by anorexia. While it may be some time before mainstream medicine embraces cannabis as part of an overall treatment program for anorexia, clearly it hasn’t stopped patients in states where it is (and isn’t) a qualifying condition. However, while research continues to shed light on how cannabis may or may not play a role in recovery, prospective patients should consult a professional and carefully consider the pros and cons of cannabis as a treatment before embarking on a cannabis-based treatment regimen.

Can Medicinal Marijuana Treat Depression?

There is evidence that marijuana works for some psychiatric disorders. Principally depression and bipolar disorder. Among some people, marijuana is jokingly referred to as “green Prozac”. “I think cannabis has a lot of potential in the treatment of mental illness,” says Lester Grinspoon, emeritus professor of psychiatry at the Harvard School of Medicine. He says that it can be an effective treatment for bipolar disorder and depression. Like any medicine, he cautions, ” it will not work for everyone. ” Grinspoon has, over the last three decades, been one of the few psychiatrists willing to speak publicly on ” mental marijuana.” Two weeks ago, the Israeli army said it would provide, on an experimental basis, medical marijuana to troops suffering from post-traumatic stress disorder, another mental illness. Good enough for an army, good enough for me. The Washington Medical Quality Assurance Commission was petitioned to add mental illness to its list of approved uses of medical marijuana. The commission denied the request. It argued that there was no rock-solid scientific evidence that weed worked for mental illness. The odd thing is that it had approved pot for treatment of Alzheimer’s, Crohn’s disease, chronic pain, and wasting syndrome based upon –– anecdotal evidence. Yes, Clinical depression is a very serious illness. People with this condition have long-term, often debilitating feelings of sadness and low self-esteem. There can be suicidal thoughts. Depression makes ordinary tasks such as going to work, cooking, cleaning, even personal hygiene, very difficult. Once a doctor has evaluated the symptoms, prescription medications are routinely prescribed. There are many types of anti-depressant medications: tricyclic antidepressants, MAOs (monoamine oxidase inhibitors), SSRIs (selective serotonin reuptake inhibitors), SNRIs neither (serotonin nor epinephrine reuptake inhibitors) and a few others. A very recent analysis published in the Journal of the American Medical Association (Jan 2010) stated that antidepressants are only effective for those with severe depression. Those patients with mild to moderate depression had no benefits with prescribed medications. However, these medications are prescribed with alarming frequency to those patients who may not benefit. Pharmaceutical companies profited $9.6 billion in 2008 on antidepressants alone. Is it about your health and well-being or about money? To add insult to injury, the side effects of antidepressants can be serious and unacceptable for many people. Sometimes the side effects are worse than the symptoms of depression. Here are some of the side effects of each type of medication: Tricyclics: blurred vision, constipation, difficulty urinating, worsening of glaucoma, impaired thinking, fatigue, high blood pressure MAO inhibitors: weakness, dizziness, headaches, tremors, deadly if mixed with certain other drugs SSRIs: loss of appetite, weight loss, insomnia, nausea, nervousness, insomnia, headache, sexual problems SNRIs: loss of appetite, weight loss, insomnia, fatigue, headache, sexual problems, liver failure, high blood pressure With many of these medications, there is also, what is called “discontinuation syndrome” – otherwise known to regular people as bad withdrawal! You cannot just stop most of these types of medications as you can become very ill. Patients who choose to stop these types of medications find that they must taper the dose with a physician’s supervision or they are unable to stop the medication. Another very concerning issue regarding these medications is that there is an increased risk of suicide, especially in younger patients. The jury is still out on this but Great Britain has banned the use of antidepressants in those younger than 18, and the FDA now requires all antidepressants to carry a warning that states that they carry an increased risk of suicidal thoughts and behaviors. Scary! Medical cannabis has been used for centuries to treat depression. An English clergyman named Robert Burton stated in 1621 that cannabis was helpful to treat depression. It was used for depression over 400 years ago in India. In the 17th century, physicians in England to treat depression prescribed it. In 1890, a British physician named J.R. Reynolds reviewed the previous 30 years of use of cannabis and determined that cannabis was helpful for depression and other illnesses (asthma, certain forms of epilepsy, nerve pain, painful menstrual cramps, migraines, and tics). More recently, patient surveys show that many people to treat depression with good results are using cannabis. Many studies also show that patients who have depression because of another debilitating disease, such as cancer, HIV, multiple sclerosis or chronic pain, report fewer depression symptoms with the use of cannabis. Researchers have found that low doses of cannabis increased serotonin levels in the brain, which helps to improve mood. Higher doses of cannabis tended to increase symptoms of depression because the serotonin levels were depleted. There are many conflicting scientific studies about the use of cannabis for depression. Many people with depression are using currently medical cannabis, but patients must be careful to use low to moderate doses so as not to cause worsening of symptoms. If patients find that symptoms are worsening, cannabis use should be curtailed. Chronic heavy use of cannabis is not recommended, but in low doses, patients may find the relief they need without the unwanted side effects from conventionally prescribed medicines. Other treatments in combination with medical cannabis may help to improve results, such as therapy or counseling, exercise, and a healthy diet with natural foods. Marijuana and depression have a sort of love-hate relationship. Some experts believe that marijuana can lessen the effects of depression. Others say using it can cause depression. The Mayo Clinic says the two conditions often accompany each other. However, there is just not enough evidence to prove that marijuana – or cannabis – can cause depression. The jury is still out. According to Fox News, a study showed that at low doses, marijuana is a powerful antidepressant. However, if an individual uses high doses, the symptoms of depression actually get markedly worse. When an individual smokes marijuana at low doses, the active ingredient in the plant, THC, increases serotonin, a neurotransmitter that regulates the mood. The effect is similar to the one achieved by taking SSRI antidepressants such as Prozac. The study to which Fox referred appeared in the October 24, 2007 issue of The Journal of Neuroscience and used laboratory rats as subjects. The research was conducted by staff members from McGill University, Le Centre de Recherche Fernand Seguin Hospital in Quebec, and Universite de Montreal in the city of the same name. The researchers injected the rats in the study with a synthetic cannabinoid. They followed up by testing the animals for so-called “depression” by using a standard technique known as the forced swim test. When THC is smoked at high dosages, the opposite mental state occurs. Depression can get worse, and other psychiatric conditions such as psychoses might appear. During the study, researchers witnessed an antidepressant effect from the cannabinoids. The neurons that make serotonin and affect mood experienced an increase in activity as well. Upping the cannabinoid dosage above a certain point, however, obliterated any benefits from the drug. The link between marijuana and reducing the symptoms of depression is in the intoxicating effects of the plant. Scientists believe this is because of the chemical similarity of marijuana and natural chemicals in the brain called endocannabinoids. The human body releases these substances when it experiences pain or extreme stress. By utilizing structures known as cannabinoid CB1 receptors, endocannabinoids are able to interact with the brain. Results of the rat study suggest that these receptors directly affect the cells that manufacture serotonin. Does this mean that if marijuana use were legal in all states, an individual could count on using the plant in some way to relieve depression? Hardly. Probably the biggest reason is that it is so difficult to control the dosage of natural marijuana. This is particularly true when it is smoked; perhaps the only practical way to use it is as an antidepressant. The greatest value of this study might be that it suggests that excessive use of cannabis by people who are already depressed could result in psychosis. If the medical community ever recognizes the plant as a legitimate treatment for depression, patients will still face the hurdle of getting their hands on it. According to ProCon.org, Fourteen states have approved the use of medical marijuana. All 14 states require proof of residency to be considered a qualifying patient for medical marijuana use. Although a variety of drugs are available for the treatment of depression, therapy is not effective in all cases and so finding alternative options is desirable. Reports by patients using cannabis and observations from clinical studies where cannabinoids were used suggest an anti-depressive potential for the use of medical marijuana. From 2003 to 2006, A study with 75 patients suffering from depression, stress and burnout syndrome were successfully treated in a practice for general medicine with the cannabis ingredient Dronabinol, alone and in combination with other antidepressants. The results of the study suggested that Dronabinol has an antidepressant potential. Science Daily (Oct. 24, 2007) — A new neurobiological study has found that a synthetic form of THC, the active ingredient in cannabis, is an effective anti-depressant at low doses. However, at higher doses, the effect reverses itself and can actually worsen depression and other psychiatric conditions like psychosis. It has been known for many years that depletion of the neurotransmitter serotonin in the brain leads to depression, so SSRI-class anti-depressants like Prozac and Celexa work by enhancing the available concentration of serotonin in the brain. However, this study offers the first evidence that cannabis can also increase serotonin, at least at lower doses. Laboratory animals were injected with the synthetic cannabinoid WIN55, 212-2 and then tested with the Forced Swim test — a test to measure “depression” in animals; the researchers observed an antidepressant effect of cannabinoids paralleled by an increased activity in the neurons that produce serotonin. However, increasing the cannabinoid dose beyond a set point completely undid the benefits said Dr. Gabriella Gobbi of McGill University. “Low doses had a potent anti-depressant effect, but when we increased the dose, the serotonin in the rats’ brains actually dropped below the level of those in the control group. So we actually demonstrated a double effect: At low doses, it increases serotonin, but at higher doses, the effect is devastating, completely reversed.” The anti-depressant and intoxicating effects of cannabis are due to its chemical similarity to natural substances in the brain known as “endocannabinoids”, which are released under conditions of high stress or pain, explained Dr. Gobbi. They interact with the brain through structures called cannabinoid CB1 receptors. This study demonstrates for the first time that these receptors have a direct effect on the cells producing serotonin, which is a neurotransmitter that regulates the mood. Dr. Gobbi and her colleagues were prompted to explore cannabis’ potential as an anti-depressant through anecdotal clinical evidence, she said. “As a psychiatrist, I noticed that several of my patients suffering from depression used to smoke cannabis. In addition, in the scientific literature, we had some evidence that people treated with cannabis for multiple sclerosis or AIDS showed a big improvement in mood disorders. But there were no laboratory studies demonstrating the anti-depressant mechanism of cannabis.” Because controlling the dosage of natural cannabis is difficult — particularly when it is smoked in the form of marijuana joints — there are perils associated with using it directly as an anti-depressant. “Excessive cannabis use in people with depression poses a high risk of psychosis,” said Dr. Gobbi. Instead, she and her colleagues are focusing their research on a new class of drugs, which enhance the effects of the brain’s natural endo-cannabinoids. “We know that it’s entirely possible to produce drugs which will enhance endo-cannabinoids for the treatment of pain, depression, and anxiety,” she said. The study, published in the October 24 issue of The Journal of Neuroscience, was led by Dr. Gabriella Gobbi of McGill University and Le Centre de Recherche Fernand Seguin of Hôpital Louis-H. Lafontaine affiliated with l’Université de Montréal. The first author is Dr. Gobbi’s McGill Ph.D. student Francis Bambico, along with Noam Katz and the late Dr. Guy Debonnel* of McGill’s Department of Psychiatry. Story Source: McGill University (2007, October 24). Cannabis: Potent Anti-depressant In Low Doses Worsens Depression At High Doses. Science Daily. Retrieved April 29, 2011, from http://www.sciencedaily.com/releases/2007/10/071023183937.htm

Cannabis and ADD/ADHD

Cannabis and ADD/ADHD In the eyes of popular culture, cannabis consumers aren’t exactly models of concentration and cognitive performance. So when a small group of researchers began exploring cannabis as an alternative treatment for attention deficit disorders, there was, of course, some scoffing and skepticism. Nevertheless, with so many medical marijuana patients swearing by its ability to promote focus in place of prescription stimulants, these doctors sought to take a closer look at the scientific basis of this counterintuitive phenomenon. Attention deficit hyperactivity disorder, better known as ADHD, is a controversial diagnosis marked by distractibility, hyperactivity, and impulsivity. Adults are more likely to be diagnosed with attention deficit disorder or ADD, which lacks this hyperactivity characteristic but is similar in other ways to ADHD. More than one in 10 children in the U.S. will be diagnosed with ADD/ADHD, a figure that has grown exponentially in the last 50 years. Since 1957, doctors have been treating ADD/ADHD patients with psychostimulants like Adderall, Ritalin, and Concerta. Antonio Rodriguez, diagnosed with ADD/ADHD at age six, had been among the masses prescribed stimulant medications. “I remember having headaches all the time to the point where I wasn’t able to sleep,” Antonio said, adding that his appetite was also nonexistent until treating with cannabis; and not only was cannabis lifting the stimulant side effects, it improved Antonio’s ADD/ADHD symptoms. “For the first time ever, I was in the state where I could really get my mind together.” Having only been taught the dangers of using cannabis, Antonio was cautious about trying it for the first time. “I got scared about the whole ‘addiction’ side of cannabis,” Antonio said. “I was waiting for the moment my body asked me for weed, but it never happened.” For those coming from an anti-cannabis background, explaining its therapeutic properties to friends and family can be difficult. This was no less true for Antonio, despite the fact that his performance in school had won him college acceptance with a scholarship. The reality is, there’s far too little research on cannabis and ADD/ADHD to know exactly how the two interact. Still, the data and results emerging from initial investigations show that there is more digging to be done. One main physiological irregularity of ADD/ADHD is the brain’s shortage of dopamine, a chemical neurotransmitter involved in cognitive processes like memory and attention. Medications like Adderall and Ritalin stimulate dopamine, thereby promoting concentration, but come with a myriad of unpleasant side effects and withdrawal symptoms. Dr. David Bearman, a figurehead of cannabis research, has studied the relationship between the cannabinoid system and ADHD and discovered potential therapeutic value as cannabinoids interact with the brain’s dopamine management systems. “Cannabis appears to treat ADD and ADHD by increasing the availability of dopamine,” Dr. Bearman wrote. “This then has the same effect but is a different mechanism of action than stimulants like Ritalin (methylphenidate) and Dexedrine amphetamine, which act by binding to the dopamine and interfering with the metabolic breakdown of dopamine.” Put simply, the compounds found in cannabis, called cannabinoids, could potentially correct the dopamine deficiency observed in ADD/ADHD patients if dosed appropriately and administered safely. Even in its raw form, cannabis is able to provide the mental slowdown necessary for concentration in many patients. Boring and arduous tasks become more manageable, and mood swings tend to level out. But why? “The most accepted theory about ADHD rests on the fact that about 70 percent of the brain’s function is to regulate input to the other 30 percent,” Dr. Bearman says. “Basically the brain is overwhelmed with too much information coming too fast. In ADHD, the brain is cluttered with and too aware of all the nuances of a person’s daily experience.” While most medical professionals agree that anecdotal evidence is not sufficient in recommending cannabis for ADD/ADHD, researchers are optimistic about the potential cannabis is demonstrating. When political blockades let up and further research resumes, it could be that cannabinoid therapy provides a frontier for safer, more effective ADD/ADHD medication.

Cannabis and Epilepsy Treatment

Since medicinal cannabis has become a more commonplace alternative for a well-established list of ailments, patients are finding a place for it next to their Advil and Tums. But unlike many other chronic illnesses that can be managed with over-the-counter supplements, epilepsy requires a specific cocktail of chemicals not readily available at the local corner store. This is why cannabis – specifically its chemical constituent CBD (cannabidiol) – has become so important for families struggling to treat their epileptic loved ones. Cannabis has demonstrated so much promise in the treatment of epilepsy that FDA-approved clinical trials are underway. But why is it that cannabis, in particular, is so effective at treating seizures, and why is it critical that clinical investigations continue? What is Epilepsy and What Causes It? Epilepsy is characterized by recurring seizures of variable intensity and effect. These seizures are usually caused by disturbances in specific regions of the brain’s circuitry that create storms of extra electrical activity. Approximately 1 in every 26 Americans will develop epilepsy in their lifetime, and two-thirds of those diagnosed will have no specific origin for the disorder. But perhaps the most harrowing fact is that 34% of childhood deaths are due to epilepsy or accidents that occur during seizures. These figures illustrate the “hiding in plain sight” commonality of epilepsy and the incredible unmet need for the development of novel drugs to treat seizures. While a seizure disorder can be a massive disruption to someone’s way of life and can even be deadly, most patients manage to acquire treatment and medicine while others simply grow out of it – though this is not always the case. Seizures and seizure disorders are as unique as the person afflicted by them, which can make seizures difficult to treat. Recently, epilepsy and cannabis have been highlighted in the news, especially success stories focusing on children with epilepsy who are trying medicinal cannabis. A few notable examples include Charlotte Figi and the high CBD Charlotte’s Web cannabis strain named after her, as well as Renee and Brandon Petro. These cases and others have shone a spotlight on the medicinal uses of cannabis, regardless of its classification as a Schedule I narcotic (having no medicinal use in the eyes of the Federal government) and the generally accepted legal age of consumption for mind-altering substances (save caffeine and sugar). The Current State of Cannabis and Epilepsy Research These inspiring stories help illuminate the efficacy of medical cannabis while defining its range of treatment from the elderly to the young. While the capabilities of CBD and medical cannabis use seems to be self-evident, the DEA has only recently allowed academic institutions to explore the effects, side effects, and the usefulness of cannabis as a medicinal plant. This seemingly innocuous change of face is an enormous leap forward for researchers, pharmaceutical companies, breeders, and the cannabis community at large as more scientific capital is put toward understanding this populous plant. “Based on these preclinical studies, one would be excited about the potential therapeutic potential of the cannabinoids,” wrote Dr. Francis M. Filloux in the journal Translational Pediatrics. “However, it is undeniable that the complex regulation that surrounds these Schedule I substances has impeded a scientific investigation of their therapeutic potential.” There has been no other drug in history that has been as widely consumed and applied for medicinal use without the institutional blessing symbolized by clinical human trials. But patients around the country currently have access to the “generic” versions of life-saving, CBD-rich cannabis products that are thriving beyond the regulatory reach of the FDA. So by conducting clinical trials with pure CBD, as GW Pharmaceuticals is with Epidiolex, concrete, tested scientific evidence can lay the first bricks in the road toward a variety of CBD/THC ratio products as well as synergistic cannabis cocktails targeted at other specific maladies. Clinical trials become more rigorous and far-reaching as they progress through each stage. Currently, GW Pharmaceuticals is undergoing Stage 3 clinical trials on Epidiolex, a nearly pure CBD preparation (98%+), to confirm the therapeutic value of this cannabinoid. This is also an astounding leap forward for cannabis and medicine, because, as noted by Dr. Filloux: “Until the last few years, the published data was minimal and included [fewer] than 70 subjects. Very few of these were children. Furthermore, none of these studies would meet criteria as Class I-III clinical trials (50-53). However, this state of affairs is rapidly changing given the current climate.” While this scientific success story isn’t a tear-jerker like Brandon’s or Charlotte’s, it does explain a necessary step toward proving the efficacy of cannabis-based therapies and its more egalitarian medicinal prescription. Why Does Cannabis Work for Epilepsy and Seizures? The endogenous cannabinoid system is ubiquitous in our bodies and is heavily regulated by cannabinoids found in cannabis. With such potent biological usefulness throughout the human body, it’s obvious that the more scientific study that goes into the cannabis industry and the plurality of products it has created, the more the consumer will benefit. Time will be a better judge, but the future of medicinal cannabis as a treatment for disorders like epilepsy is here.

Cannabis Can Help Migraine Sufferers

Cannabis has long been used for the treatment of migraines, but only in recent years have scientists closed in on the reasons why. A new study published this week from Skaggs School of Pharmacy and Pharmaceutical Sciences at the University of Colorado looked at the effects of inhaled and ingested cannabis in migraine sufferers, and the results confirmed what previous studies had begun to unearth. Researchers reviewed reports from 121 adult participants and collected the following data: The average number of migraine headaches decreased from 10.4 per month to 4.6 Almost 40% of subjects reported positive effects 19.8% of subjects claimed medical marijuana helped to prevent migraines 11.6% of subjects reported that cannabis stopped migraine headaches About 85% of subjects reported having fewer migraines per month with cannabis About 12% saw no change in migraine frequency with cannabis Only about 2% experienced an increase in migraine frequency Inhalation methods appeared to provide the fastest effects and were more likely to stop migraine headaches in their tracks. As expected, edible cannabis took longer to provide relief and was more likely to induce negative side effects like sleepiness and overly intense euphoria (which was reported in 11.6% of participants). Past studies attempted to understand why cannabis tends to help migraines, citing endocannabinoid deficiencies and activation of CB2 receptors as possible explanations. This particular study didn’t help to answer those questions, but it did add to the growing body of research supporting the use of cannabis as a migraine medication, given the fact that over 85% of participants saw a reduction in migraine frequency.

Cannabis Used For Stress Relief

In recent IDMU surveys, relaxation and stress relief were overwhelmingly the most commonly perceived benefits of cannabis use. However, the Department of Health identifies panic attacks and anxiety as effects of acute cannabis intoxication, particularly among naive users, in justifying the refusal of the UK Government to permit the prescribing of cannabis. Recent advances in fundamental cannabinoid research have been interpreted as indicating a common modality of action of cannabis and opiate drugs, in that naloxone (an opiate antagonist) blocks cannabinoid-induced dopamine release in the limbic system (a primitive brain structure associated with control of emotion and mood) and the a cannabinoid antagonist administered to rats, pretreated with a powerful synthetic cannabinoid agonist, can precipitate corticotrophin-releasing factor (CRF) which is held to be the mechanism responsible for mediating the psychological aspects of drug withdrawal symptoms, and leading to anxiety-type behaviours. This was interpreted as demonstrating a cannabis withdrawal syndrome, however, the potency of the synthetic cannabinoid used was many times that of THC, and the administration of an antagonist (blocker) would not effectively mimic the gradual decrease in plasma THC which occurs with cessation of normal use. The fact that a potent cannabis blocker caused anxiety symptoms in rats would be consistent with a general diminution of anxiety levels arising from cannabis use. Laurie reported that in a few cases ‘ anxieties, which may approach panic, often associated with a fear of death or an oppressive foreboding is infrequently seen, usually giving way to an increasing sense of calmness to euphoria’. Grinspoon refers to the initial state as a ‘happy anxiety’ where the experience is internally redefined as pleasurable. Rosenthal reports that panic reactions and anxiety are rare, and most commonly found with overdose (particularly from oral preparations), in naive users, or in those who do not like the effects of marijuana, and attributed the incidence of anxiety reports with Marinol (dronabinol – pure THC) to the lack of CBD within the preparation. Mikuriya considered that ‘the power of cannabis to fight depression is perhaps its most important property’. Patients were reported to self-medicate with cannabis rather than use benzodiazepines as the former produced less dulling of mental activity. The authors cited one study where marijuana was found to increase anxiety in naive users, but to decrease anxiety inexperienced users, and another of 79 psychotics who used marijuana recreationally and reported less anxiety, depression, insomnia or physical discomfort, and concluded that natural marijuana containing CBD and THC appeared more effective than THC alone in treating depression, and that patients suffering stress as a result of pain or muscle spasms would be most likely to be helped by the drug. They differentiated the use of cannabis to cope with everyday life stresses from the use of benzodiazepines in treating ‘severe anxiety disorders’ with an organic etiology. Bello in a passionate treatise on the benefits of cannabis for physical and mental health likened the anxiolytic effect of marijuana to a state of relaxed alertness brought on by ‘balancing’ the autonomic nervous system. Explanations of the panic and anxiety experienced by some naive users exposed to cannabis would include ‘set and setting’ i.e. a drug taken in the course of a laboratory experiment would provide different expectations of an experience to an informal party or gathering of friends, secondly the increase in heart rate can be interpreted by some older users as a heart attack and cause panic attacks, this ‘tachycardia’ is normally associated with a reduction in blood pressure, the combined effect is analogous to changing down a gear in a motor vehicle. Some individuals may be more susceptible to the effects of cannabis than others, and those whose initial experience is unpleasant may be more likely to discontinue use of the drug. By contrast, many first-time users fail to notice the influence of the drug. Thompson & Proctor, treating withdrawal conditions, noted the synthetic cannabinoid pyrahexyl to produce significant increases in alpha brain waves, indicating increased relaxation, and Adams reported similar results. However, Williams found no significant increase in alpha activity either with parahexyl or smoked marijuana. In laboratory animals, the cannabinoid receptor has been linked to modulation of emotional behavior reinforcement, learning, and memory. Musty compared the effects of THC, CBD (cannabidiol) and diazepam (valium) on anxiety-related behaviors in mice. THC produced similar reductions in anxiety behaviors to diazepam, however, the effect of CBD was more pronounced than either in measures of shock-avoidance, grooming, and reduction of delirium tremens in alcohol-withdrawn mice. Both THC and CBD produced dose-related reductions in ulcer formation in stressed mice. However, in all tests the CBD dosages used were higher than THC dosages. Mechoulam reviewed studies of Nabilone (a synthetic cannabinoid) on anxiety, finding two studies which suggested a superior effect on anxiety, mood, and concomitant depression, whereas two other studies found little or no effect. Benowitz & Jones reported initial tachycardia and hypertension in volunteer subjects administered up to 210mg THC per day, but found a development of tolerance to tachycardia and CNS effects over the 20-day experiment, with blood pressure reduced and stabilized at around 95/65. Fabre & McLendon reported a dramatic improvement in anxiety in the nabilone-treated group compared to placebo. Nakano reported anti-anxiety effects of nabilone and diazepam in a controlled trial of experimentally-induced stress but was unable to conclude which was more effective due to differences in dosage and metabolism. Hollister reported these and other nabilone studies indicating significant anti-anxiety effects of low doses and commented on the scarcity of studies of potential anti-anxiety effects of cannabinoids. Davies, in a study of cancer patients, considered the management of stressful patients to have been improved by oral THC. However, a study of intravenous THC used as a premedication for oral-facial surgery found that patients showed a pronounced elevation of anxiety, and considered noxious stimuli to be more painful. Mechoulam, considered a number of synthetic cannabinoids to be worthy of investigation as potential sedative-relaxants.

Does Marijuana Help Treat Glaucoma?

Glaucoma is a common eye condition that often causes optical nerve damage, and when left untreated, can lead to blindness. In the U.S., more than three million Americans live with glaucoma. Globally, the figure is close to 60 million. Glaucoma is recognized as one of the leading causes of irreversible blindness. Since 1980, surgical procedures and treatments have improved significantly, cutting the risk of developing blindness nearly in half. Nonetheless, while treatment has improved, the number of effective topical drugs remains limited. Recognized near universally in medical marijuana states as a qualifying condition, increasing numbers of people have turned to cannabis to treat their condition. But should they? Given the improvement of existing glaucoma treatments, do the benefits of medical cannabis outweigh the potential side effects or risks? Likewise, given the vital role the body’s endocannabinoid system plays in disease, what promise does the future hold for developing cannabinoid-derived medications to treat cannabis? What Causes Glaucoma? Evidence increasingly suggests glaucoma (now widely considered to be a neurodegenerative condition), has a connection to other neurodegenerative diseases like Alzheimer’s disease. Studies have shown one out of four Alzheimer’s patients also likely has a diagnosis of glaucoma. In fact, glaucoma appears to be a significant predictor of an AD. A precise cause of glaucoma, however, remains a mystery and continues to elude the scientific community. Current Glaucoma Treatment Options Because intraocular pressure (IOP) influences onset and progression of glaucoma, ophthalmologists prescribe treatments that target intraocular pressure. In fact, the only way to prevent vision loss (or eventual blindness) is to lower IOP levels. Depending on the severity and progression, ophthalmologists may treat glaucoma with medications such as prescription eye drops or, if necessary, surgery. Can Cannabis be Used for Glaucoma Treatment? Going back to the 1970s, studies have shown that cannabinoids can alleviate glaucoma-related symptoms because they lower the intraocular pressure (IOP) and have neuroprotective actions. For example, in 1971, one of the first studies of its kind found ingestion of cannabis lowers IOP by 25 to 30 percent. Despite the findings from early research, very few ophthalmologists support the use of medical marijuana in patients with early to mid-stage glaucoma. The main issue ophthalmologists have with cannabis is that the potential adverse effects — particularly smoking cannabis — outweigh the short-term benefits. For example, smoking can lead to unstable intraocular pressure, thereby increasing the risk of permanent vision loss. Further, because its therapeutic effects on glaucoma are short-term, patients would have to consume cannabis frequently — once every three to four hours. Doctors claim that because glaucoma needs to be treated 24 hours per day, patients would need to consume cannabis six to eight times over the course of a day to achieve consistently lowered IOP levels. Such frequency is hard to maintain and could increase the risk of developing a cannabis use disorder. However, when it comes to late-stage glaucoma, ophthalmologists are more inclined to embrace cannabis as a treatment. At the end stages of glaucoma, it’s less about directly targeting glaucoma and more about alleviating the accompanying symptoms. According to ophthalmologist Andrew Bainnson, MD, “We’ve known for some time that medical marijuana is very effective for treating nausea and pain, but not so much for glaucoma,” said Bainnson. “[However,] there are some patients with end-stage pain and nausea who may benefit [from medical marijuana], but not from the glaucoma point of view.” Could Cannabis-Based Treatments Play a Greater Role in the Future? The body’s own internal cannabinoid system, called the endocannabinoid system (ECS), is one of our most important physiological systems. Nearly every aspect of our health — including inflammation, immune response, neuroprotection, pain modulation — are all dependent on the ECS. Given the vital role of the ECS, particularly in neuroprotection and inflammation, many scientists believe the development of cannabinoid-based medications could be immensely useful in treating (and preventing) glaucoma. Cannabinoid receptors are prominent in ocular tissues responsible for regulating intraocular pressure. A promising area of research would be to develop cannabinoid-derived medications that target these tissues. Cannabinoid-derived medications could be developed that serve two roles: lowering IOP and protecting retinal cells. Evidence suggests two cannabinoid agonists — WIN 55212-2 and anandamide — and several cannabinoids including CBD and CBG (cannabigerol), may be good candidates to develop as therapeutic agents, particularly because even when administered topically (directly to the eye), they are well tolerated. However, challenges not unique to cannabis persist. Oral preparations are not good because bioavailability is poor and absorption is too unpredictable. Inhalation isn’t ideal, because the effects don’t last long enough. That leaves topical preparations. And, currently all forms of eye drops — while superior to oral and inhalation administration — do a poor job of penetrating intraocular tissues. Up to 95% of an administered dose fails to reach the intended target. What Are Cannabis Topicals and How Do They Work? While cannabis, as it is administered today, may not be an ideal treatment for glaucoma, the development of cannabinoid-derived medications represents promising future directions. And, whether or not cannabis is an ideal glaucoma treatment, there are some people who swear by it as being a godsend for their glaucoma. Others use cannabis as an adjunct to therapy, but not as their primary treatment.

Medical Marijuana and Crohn’s Disease

There is a growing awareness around alternative treatments for chronic diseases. Many patients are searching for natural remedies as a means of supplementing their current conventional treatments. Others are opting for herbal solutions because they aren’t responding to their prescription medications or they’re experiencing intense side effects from them. This appears to be particularly concerning among Crohn’s disease patients. Many sufferers are pursuing medical marijuana for Crohn’s disease either as a primary or complementary treatment to this chronic and debilitating condition. What Is Crohn’s Disease? Crohn’s disease is an incurable chronic disease of the intestinal tract. Symptoms include abdominal pain, weight loss, fever, rectal bleeding, skin and eye irritations, and diarrhea. Crohn’s disease is one of two main types of inflammatory bowel diseases (IBD). The other type is ulcerative colitis. Crohn’s disease affects the lining of the gastrointestinal tract (GI). Crohn’s disease causes severe pain, and in rare cases, is life-threatening. Crohn’s disease can cause inflammation throughout various parts of the digestive tract from the mouth to the rectum. While it can affect each patient differently, it most commonly affects the part of the GI tract where the small intestine joins the colon. The inflammation can be so severe that it develops within the deepest layers of the intestinal tissues. Crohn’s disease is a debilitating and painful disease that can cause fatal complications in some cases. It’s characterized by periods of flare-ups and remission. Flare-ups are periods where inflammation is at its highest and symptoms are most painful. Many patients achieve long periods of remission where they manage inflammation and symptoms. These fluctuations in disease activity can come and go several times throughout a patient’s life. Crohn’s disease most often develops between the ages of 20 and 40, although children and older adults can also develop it. An estimated 700,000 Americans suffer from Crohn’s disease, though the number is probably much higher due to undiagnosed or misdiagnosed cases. The disease equally affects both men and women. Crohn’s Disease History The timeframe surrounding the earliest known reports of Crohn’s disease is debatable. Crohn’s disease has many general symptoms that can stem from many different possible causes, so it’s difficult to say if ancient reports of bowel inflammation were due to Crohn’s disease. History shows that the Ancient Greek doctors, including Hippocrates, reported chronic diarrhea in patients with 460-370 BCE. Though it wasn’t termed Crohn’s disease at the time, it’s possible that the cause of chronic diarrhea observed in patients at the time may have been some form of inflammatory bowel disease. Ancient Chinese medicine records also show that healers used traditional Chinese herbal remedies to treat sets of symptoms like gut inflammation, abdominal pain, diarrhea and intestinal infections. Ulcerative colitis, a related inflammatory bowel disease, was officially discovered before Crohn’s disease. Ulcerative colitis was officially recorded and defined in 1895. Sir Thomas was the first to describe a form of what would later be known as Crohn’s disease. In 1915, he described a condition he called chronic intestinal enteritis, but he died before he could continue to define the disease fully. In 1932, Burrill Bernard Crohn, Gordon Oppenheimer, and Leon Ginzburg were the first doctors to officially discover and name Crohn’s disease. Today, researchers are continuing to discover more about Crohn’s disease to find a cure. Multiple research foundations, including the Crohn’s and Colitis Foundation, are working to support and fund ongoing research into inflammatory bowel diseases to help treat and prevent severe cases. Crohn’s Disease Causes Researchers still don’t know exactly what causes Crohn’s disease. Common belief used to be that high-levels of chronic stress or dietary factors triggered it. Today, researchers feel that these are both aggravating factors, but not direct causes. Instead, there is likely a combination of factors that may play a role in developing Crohn’s disease. These factors include: Family History: Genetics may play a role in the development of Crohn’s disease. Around 25% of people with Crohn’s disease have a family member with the disease. Immune System Health: Researchers feel it’s possible that Crohn’s disease is triggered by an immune response to a virus or type of bacteria. Instead of only attacking the invading microorganism, the immune system responds by attacking healthy intestinal cells as well. This is why some people refer to Crohn’s disease as an autoimmune condition, but researchers haven’t proven this conclusively. Doctors have identified certain risk factors associated with developing Crohn’s disease. These risk factors include: Age: Most people diagnosed with Crohn’s disease are under the age of 30, though it can affect anyone at any age. Ethnicity: People of Jewish heritage are three to six times more likely to develop Crohn’s disease than other ethnicities, though people of all ethnicities can develop the disease. Lifestyle: Cigarette smoking, being overweight, eating a diet high in saturated fats, and living in an urban and industrialized area may make you more likely to develop Crohn’s disease. Northern Climates: People with low exposure to sunlight who live in northern climates appear to be at greater risk of developing Crohn’s disease. Crohn’s Disease Effects on the Body Because Crohn’s disease directly affects digestive health, it can cause many other effects on lifestyle including physical and mental health. It also poses a risk of developing other conditions and diseases. Here are some of the possible effects of Crohn’s disease: 1. Malnutrition: Malnutrition refers to an inadequate intake of essential vitamins and nutrients in the body. Malnourishment can cause many symptoms like weight loss, loss of muscle mass and poor appetite. Crohn’s disease can lead to malnutrition for many reasons including blood loss in the gut and an inability to absorb nutrients properly due to the digestive system being in a constant state of inflammation. Crohn’s disease sufferers also experience malnutrition because they choose not to eat in many cases out of fear of triggering intestinal pain and diarrhea. While there’s no evidence to indicate that foods actually cause Crohn’s disease inflammation, certain people may experience aggravated symptoms due to certain types of foods. 2. Fatigue: Around 75% of people with Crohn’s disease report feeling severe fatigue, and there are many reasons why. Crohn’s sends the body into a chronic state of inflammation, which the body is constantly using energy to fight. Crohn’s disease also causes blood loss from stools in certain patients. This can cause an iron deficiency (anemia), which is known to lead to chronic fatigue. There’s also a vicious circle involved. Crohn’s disease patients are always tired, so they don’t have enough energy to exercise. And because they don’t exercise, they experience low energy levels. Part of managing Crohn’s disease symptoms is understanding these effects and attempting to correct them through lifestyle adjustments. 3. Depression and Anxiety: Depression and anxiety are common conditions to experience within the year following a Crohn’s disease diagnosis. When you look at the symptoms that plague Crohn’s disease patients, it’s no wonder that it can lead to depression and anxiety. Malnutrition, low energy levels, and chronic abdominal pain can affect the mental health of many patients. Additionally, Crohn’s disease can have an impact on a person’s social life. If they find themselves in the middle of a flare-up, it can cause debilitating symptoms, which prevent them from being able to go out and enjoy life. 4. Cancer Risk: Patients with Crohn’s disease are at an increased risk of developing colorectal cancer compared to the overall population. Patients who have a longstanding history of Crohn’s disease over a 20-year period or more and who were diagnosed at a young age are, particularly at risk. Researchers are continuing to investigate colorectal cancer screening tools to help identify risks in certain Crohn’s disease patients. Experts advise that because of this increased risk, patients with Crohn’s disease may need to undergo colonoscopy screening sooner and more frequently than the general population. The general population is advised to undergo colonoscopy screening every 10 years after the age of 50. Crohn’s Disease Symptoms Crohn’s disease, though an inflammatory bowel disease, produces a wide variety of symptoms. The most common Crohn’s disease symptoms include: Abdominal pain and cramping Fever Extreme diarrhea with or without blood Fatigue and chronic low energy Weight loss Malnutrition Nausea and vomiting Fatty stools that float Iron deficiency (anemia) Because Crohn’s disease is believed to be caused by an autoimmune reaction, it can produce other body-wide symptoms or conditions including: Eye infections Joint pain Skin Rashes Blood clots Mouth ulcers Crohn’s disease symptoms can range from mild to severe. Severe cases include extreme levels of weight loss and malnutrition, persistent vomiting and chronically high fever. Some people may experience different periods of different symptoms. Some flare-ups may bring about worse symptoms. Crohn’s disease is commonly associated with other conditions such as liver disease, arthritis, and osteoporosis. Traditional Crohn’s Disease Treatments Since there is no cure for Crohn’s disease, the goals of treatment are to ease the symptoms, control inflammation and improve the patient’s nutrition. Treatment options for Crohn’s disease may include a combination of: Nutritional supplements Surgery to remove parts of the digestive tract, including the colon and rectum Non-steroidal anti-inflammatory medications (NSAIDs) Corticosteroids (steroids administered orally or as an injection) Immune system suppressors Remicade (infliximab) Antibiotics Anti-diarrheal Fluid replacements Many of these medications cause additional side effects for patients to deal with. Common side effects of conventional Crohn’s disease treatments include: Dizziness Lightheadedness Nausea Itchiness and tingling Headache Fever Joint and muscle pain Chest pain Because of these difficult side effects, many patients prefer medical marijuana for Crohn’s disease as an alternative medicine. Medical Cannabis for Crohn’s Disease Cannabis has many known health benefits that can help treat Crohn’s disease symptoms. Cannabis contains over 60 different compounds, many of which have properties that can be applied in a medicinal capacity. Two of the known compounds that provide health benefits are tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the psychoactive compound found in cannabis that is responsible for delivering mind-altering effects. CBD is responsible for other health benefits like anxiety, pain and nausea relief. Some of the cannabis health benefits that address Crohn’s disease effects and symptoms include: Reducing inflammation through anti-inflammatory properties Providing pain relief through analgesic effects Lowering levels of anxiety Suppressing nausea and vomiting Increasing appetite Researchers continue to examine the connection between cannabis and Crohn’s disease treatment. Numerous studies indicate cannabis is an effective way to alleviate the symptoms of Crohn’s disease. Here are three separate studies that have yielded encouraging results for Crohn’s disease patients seeking alternative therapies: 1. Cannabis Alleviates Symptoms of Crohn’s Disease: O’Shaughnessy’s, a scientific journal, published a 2005 study, “Cannabis Alleviates Symptoms of Crohn’s Disease,” that reported that patients saw significant improvements with the use of cannabis. The study examined 12 questionnaires completed by Crohn’s disease patients. The participants were asked about their experience using cannabis on an ad-lib basis (at their own leisure). They described improvements or changes to their signs and symptoms by rating them on a scale from zero to ten. For each sign or symptoms evaluated, the patients described marked improvements in appetite, pain, nausea, vomiting, depression, fatigue and activity levels. 2. Cannabis as a Treatment for Chronic Colonic Inflammation: In 2004, the Journal of Clinical Investigation published a study titled “The Endogenous Cannabinoid System Protects Against Colonic Inflammation.” It reported that medical marijuana is a powerful anti-inflammatory that “represents a promising therapeutic target for the treatment of intestinal disease conditions characterized by excessive inflammatory responses.” 3. Cannabis Improves Disease Activity: In 2011, the Israel Medical Association Journal published a study conducted at the Meir Hospital and Kupat Holim Clinic. The study, “Treatment of Crohn’s Disease with Cannabis: An Observational Study,” examined 30 Crohn’s disease patients who consumed cannabis. All patients stated that they felt as though consuming cannabis decreased their disease activity. Twenty-one of the patients showed significant improvement in disease activity, including a reduction in symptoms and signs such as lowered frequency of bowel movements. The study’s authors had several proposed explanations for the improvement, including the anti-inflammatory benefits of cannabinoids as well as the general sense of well-being that consuming cannabis provides. Best Cannabis Strains for Crohn’s Disease Studies have shown that the Cannabis sativa plant offers great benefits for Crohn’s disease patients. Cannabis sativa is a strain of cannabis that has a high concentration of THC. Some of the recommended Cannabis sativa products for alleviating Crohn’s disease symptoms include: Jean Guy for abdominal pain Medicine Man for pain relief Hash Plant for inflammation Willie Nelson for stimulating appetite Lemon Jack for fatigue Crohn’s disease patients can choose the best strain depending on which symptoms they most want to control. Best Cannabis Uses for Crohn’s Disease Many states have approved the legal use of medical cannabis for Crohn’s disease as a pain management treatment. However, at this time there is not enough research to support a recommended protocol for cannabis use. Many of the studies for cannabis use didn’t specify a control in how the cannabis was used to treat Crohn’s disease.

Medical Marijuana and Muscle Spasms

Muscle spasms affect just about everyone, from foot cramps and midnight “charley horses” to strained and pulled muscles. Certain disorders and diseases also cause muscle spasms. Multiple Sclerosis (MS) and Amyotrophic Lateral Sclerosis (ALS) can all cause patients to experience muscle spasms that range from uncomfortable to painful. Treating these diseases, as well as the common causes of muscle spasms, often means patients must rely on traditional prescription medicine or homeopathic treatments, such as changes to your diet to reduce the chance of muscle cramps. In some cases, especially with neurological diseases, traditional prescription drugs fail to alleviate or reduce muscle cramps in some patients. Because of this, medical marijuana has become an increasingly popular option and an alternative to traditional prescription medicine, especially in states where medical marijuana is now legal. It’s also a more natural and effective alternative to everyday spasms or common muscle injuries, where opioids may be used for treatment. Learn more about medical marijuana for muscle spasms and why it’s an effective treatment below. Medical Cannabis for Muscle Spasms Muscle spasms or cramps are common, though people who are older and overweight are at a greater risk. Athletes, due to their physical activity, are also at an increased risk for muscle spasms with 67 percent of triathletes experiencing muscle cramps. Spasms can last a few seconds, a few minutes or even hours in some cases. They typically occur in your legs, but can also affect your arms and back, and any other muscle throughout your body. Intense spasms can cause also cause tears in your tendons or ligaments, especially if the tissue is already weakened or partially torn. Persistent, reoccurring spasms can also cause soft tissue to shorten, which can cause affected muscles to become rigid, difficult to use and prone to injury. A permanently stiff joint, such as in the hip, knee, shoulder, ankle or elbow is debilitating and prevents many individuals from leading the life they want. Types and Symptoms of Muscle Spasms Muscle spasm symptoms focus on a pain that’s sudden and usually brief, though it can last longer. Muscles affected by the cramp also feel tight and are tender to the touch, and can bulge. Locations of spasms are also easy to pinpoint due to the level of pain but can be misinterpreted based on their location. A headache, for example, can actually be a spasm in your neck, while a tightening of your chest could be a pectoral cramp. If you do feel tightness in your chest though, you should not hesitate to seek medical attention, as it could be signs of a more serious event like a heart attack. Numerous triggers cause the symptoms of every day or reoccurring muscle spasms. Dehydration from working outdoors or running a marathon can cause a muscle spasm, as well as the inflammation from a muscle injury, such as a torn or stretched muscle. Additional triggers for muscle spasms include: Poor blood circulation Hormone imbalance Magnesium or Potassium deficiency Prescription drug side effect Spinal cord injury Strained muscle Pinched Nerve Head exposure Chronic pain Obesity Muscle cramps are categorized into a few different categories, which are often used to diagnose a spasm if it’s reoccurring. Spasm types include: Hypertonic Muscle Spasms Hypertonic muscle spasms are characterized by a constant contraction of the muscle, which is also described as extreme muscle tone or residual tension. These spasms are also known as over-active or spastic muscle spasms and do not always cause the pain associated with cramps, though they are still straining the muscle. True Hypertonic Spasm True hypertonic spasms result from damaged or malfunctioning feedback nerves that prevent muscles from relaxing. Because damaged nerves cause a true hypertonic spasm, rather than overexertion during exercise, it requires continuous medical treatment. Stomach Spasms Stomach spasms are a type of spam that results from chronic inflammation, obstruction or distention in the stomach. Chronic conditions like Irritable Bowel Syndrome (IBS) often cause stomach spasms. Infants with colic also experience abdominal cramps. Angina Angina is a muscle spasm that results from the heart not receiving enough blood, which can be caused by heart disease and the hardening of arteries or atherosclerosis. Spasms from angina are felt in the chest, neck, shoulders, and jaw. Muscle spasms tend to be loosely categorized because they’re common and often don’t require medical treatment. Severe or reoccurring muscle spasms, such as those caused by MS, true hypertonic spasms or muscle injuries, however, need treatment. Side Effects of Prescription Treatments for Muscle Spasms Everyday muscle spasms often rely on at-home treatments, such as stretching and massaging the area to relieve the cramp. Patients who rely on prescription treatments for muscle spasms have a muscle injury or underlying disease or illness. Prescription treatments for muscle spasms include Cyclobenzaprine, Tizanidine, Baclofen and numerous other drugs. Potential side effects of these drugs include: Drowsiness Nausea Headache Dry mouth Chest pain Shortness of breath Depression Rash Additional non-prescription treatments for muscle spasms include changes to your diet, physical therapy, stretches and massage and tend to have positive side effects. These natural treatments often occur in coordination with a prescription drug treatment for patients with frequent muscle spasms. Muscle injuries may be prescribed medicine to relieve the spasm, as well as opiates for chronic pain resulting from the injury. Because opiates are best for intense, short-term pain that results from surgery, broken bones or any other severe accident, they’re not appropriate for reoccurring, chronic pain. An estimated 90 percent of patients have prescribed opioids for their chronic pain, yet research has found natural treatments provide the same relief, without the health or addiction risks of opioids. Opiates also cause side effects such as drowsiness, nausea, constipation, and liver or brain damage, as well as tolerance to the drug. Addiction is also a risk, as more than 2 million Americans abuse prescription painkillers. As noted earlier, certain drugs can cause muscle cramps as a side effect, which leads to a potential scenario where you may be given multiple drugs — one to treat your initial symptoms and a second to address that drug’s side effects. Medicines that can cause muscle spasms include: Lasix Zaroxolyn Aldactone Aricept Procardia Evista Brethine Symbicort Proventil Advair Diskus Ventolin Tasmar Crestor Lipitor Lescol Pravachol Mevacor Zocor These prescriptions are used to treat high blood pressure, cholesterol, asthma, Parkinson’s Disease and Alzheimer’s. While your doctor can prescribe a different drug for treatment to stop your spasms, a viable alternative prescription may be unavailable for some patients. Medical marijuana is a safe and natural medicine for treating muscle spasms, with minimal side effects. It’s capable of treating cramps caused by an underlying disease, other prescriptions or muscle injuries, which is why numerous states have approved it for treating muscle spasms. Why Medical Marijuana Works for Muscle Spasms Patients response to medical marijuana is why it’s approved for treating muscle spasms in many states across the U.S. States, such as Alaska, Connecticut, Pennsylvania and others approve using medical marijuana for muscle spasms caused by an underlying condition, such as MS. Certain states, like Massachusetts, also allow medical cannabis for muscle cramps if your physician recommends it. Marijuana works by reducing inflammation, which causes muscle spasms. A study by the University of South Carolina found that the immune system’s response, such as to a muscle injury, is reduced and the systems inflammatory proteins are deactivated by psychoactive THC, a cannabinoid. THC also influences the endocannabinoid system (ECS), which is a network of cell receptors throughout your body that impact your feelings of pain, which can result from inflammation in the case of muscle spasms. When medical marijuana is used, cannabinoid receptors in your ECS bind with THC and CBD, another cannabinoid. By binding to cannabinoid receptors, THC starts an anti-inflammatory response which prevents inflammation and muscle spasms after an injury, for example. A study on MS, which is characterized by inflammation that damages nerve fibers, also confirmed that medical marijuana relieves inflammation. The 2013 study demonstrated that THC and CBD reduced the phenotype responsible for inflammation in MS. Studies on the effectiveness of medical marijuana on muscle spasms tend to center on its use on muscle spasms caused by an underlying condition like MS due to the prevalence of these illnesses, as well as the fact that muscle spasms are often not chronic and are usually curable. Another MS study on muscles spasms found an oral cannabis extract improved patient’s spasticity, or muscle cramps, at twice the rate of the given placebo, while another research effort featured more than 500 subjects. More than half of the testers reported more than a 20 percent improvement in spasticity after a month of treatment with Sativex, an oral cannabis spray produced by GW Pharmaceuticals. As more pharmaceutical companies become involved in producing and distributing medical marijuana, it’s expected more research will be conducted about how and why medical cannabis affects chronic muscle spasms caused by issues unrelated to diseases like MS, such as muscle injuries. Marijuana’s proven efficacy for treating inflammation and muscle spasms make it a viable and ideal treatment option for patients, which is why so many states have approved its use as a treatment option for muscle cramps. How Medical Marijuana Helps Treats Muscle Spasms Related to MS As the studies mentioned earlier noted, medical marijuana is an effective treatment method for muscle spasms caused by MS, an immune-mediated disease. If you’re unfamiliar with MS, it’s a debilitating and sometimes fatal disorder of the central nervous system and is the most common debilitating neurologic disease of young people. More than two million people worldwide suffer from the disease, with two hundred new cases diagnosed in the United States every week. Prescription treatments for MS’ muscle spasms can cause side effects that reduce white blood cell counts, as well as lead to hair loss, lower heart rates and more, which is why medical marijuana is becoming a viable, and safer, treatment option for MS patients with muscle spasms. MS patients who use medical marijuana for multiple sclerosis have a variety of options, including smoking, edibles, vaping (using a vaporizer) and others. One of the most popular methods for sufferers of the disease is the use of cannabidiol, or CBD, which is a non-psychoactive chemical found in cannabis. CBD oil — typically taken in the form of a mouth spray — has increased in acceptance, and is available in many different countries. Patients not only report a decrease in spasticity and muscle spasms but also sleep disturbances as well as pain. Although administration of CBD through mouth spray is popular, vaping cannabis high in CBD can also help relieve pain and other symptoms. More than 50 marijuana strains of indica, hybrid and Sativa strains are available to help with MS symptoms, including muscle spasms. Patients can also take advantage of the general muscle spasm strains available, but the strains specific towards MS treat muscle spasms and additional symptoms of the disease.

What does the new bill do? (CS/CS/CS/SB 182 (2019)

Permits smoking as a route of administration for medical marijuana by amending the definition of the term “medical use” in s. 381.986(1)(j), F.S., and adds additional requirements for qualified ordering physicians when ordering smoking as a route of administration.

All other physician certification requirements under s. 381.986(4), F.S., remain in place and qualified physicians must continue to comply with both those requirements and the applicable standard of care.

When can you start ordering smokable medical marijuana?

An order for marijuana for medical use in a form for smoking may be ordered following the Governor signing CS/CS/CS/SB 182 (2019) into law.

When will smokable medical marijuana become available to patients?

Marijuana for medical use in a form for smoking will be available only from the Medical Marijuana Treatment Centers once the Office of Medical Marijuana Use approves a variance that they may request to dispense marijuana in a form for smoking. Medical Marijuana Treatment Centers must request and be granted approval for smokable product prior to dispensing.

What counts as a “marijuana delivery device”?

An object used, intended for use, or designed for use in preparing, storing, ingesting, inhaling, or otherwise introducing marijuana into the human body.

Where can patients get a marijuana delivery device?

Delivery devices intended for the medical use of marijuana by smoking need not be dispensed from a Medical Marijuana Treatment Centers and can be purchased anywhere. This only applies to devices used for smoking. Medical Marijuana Treatment Centers must still dispense all other delivery devices to qualified patients.

Can a caregiver assist?

Yes. A qualified patient and a qualified patient’s caregiver are permitted to purchase and possess a marijuana delivery device intended for the medical use of marijuana by smoking device from a vendor other than a Medical Marijuana Treatment Centers.

Are there restrictions on where smokable medical marijuana can be used?

Yes.

Can smokable medical marijuana be used in public or an indoor workplace?

No. The law specifies that medical marijuana may not be smoked in any public place and prohibits the medical use of marijuana by smoking in an “enclosed indoor workplace,” as defined in the Florida Clean Indoor Air Act.

Can a qualified patient smoke medical marijuana on their own private property?

Yes. A patient may smoke or vape medical marijuana on private property as allowed by the property owner. The law provides that s. 381.986, F.S., does not impair the ability of a private party to restrict or limit smoking or vaping marijuana on his or her private property.

Can smokable medical marijuana be used in a nursing home, hospice, or assisted living facility?

Yes, if the facility does not prohibit medical use of marijuana in the facility’s policies. The law provides that s. 381.986, F.S., does not prohibit the medical use of marijuana in a nursing home, hospice, or assisted living facility if the facility’s policies do not prohibit the medical use of marijuana.

Who must give informed consent?

Each qualified patient, or the patient’s parent or legal guardian if they are a minor, must give and sign a written informed consent before being certified to receive medical marijuana in a form for smoking that must contain information regarding the risks specifically associated with smoking marijuana.

How will a doctor provide informed consent?

Discuss with the qualified patient the negative health effects of smoking marijuana, and obtain an acknowledgment from the patient that the qualified physician has sufficiently explained the content of the informed consent.

Until the informed consent form is available, what will doctors do?

Obtain informed consent from the qualified patient specifically relating to the negative health effects associated with smoking marijuana, and obtain an acknowledgement from the patient that the qualified physician has sufficiently explained the content of the informed consent. Physicians may want to amend their current informed consent form to include the negative health effects of smoking marijuana until the Board of Medicine and Board of Osteopathic Medicine adopt the amendments to the informed consent form required by s. 381.986, F.S.

When will the new informed consent forms be available?

The Board of Medicine, Board of Osteopathic Medicine, and the Joint Committee on Medical Marijuana will be meeting in April 2019 to begin the approval process for the new informed consent forms.

Where will the new informed consent forms be available?

http://flhealthsource.gov/mum/forms

Can patients under 18 use smokable medical marijuana?

Yes. Patients under the age of 18 may not obtain a certification for marijuana for medical use by smoking unless the patient is diagnosed with a terminal condition.

How does a patient under 18 receive certification for smokable medical marijuana?

A qualified physician must certify that smoking is the most effective route of administration for medical marijuana to the patient; A. A second physician, who is a board-certified pediatrician, must concur with the determination; AND B. Such a determination and concurrence is recorded in the patient’s medical record and in the medical marijuana use registry.

For assistance amending an existing certification to include smoking, or creating a new certification, qualified physicians may call: 850-245-4657 and choose Option 2.

Example certification to be entered as an order note: “This patient is certified for the medical use of marijuana in a form for smoking. Each certification for smoking may not exceed 35 days. A 35-day supply of marijuana in a form for smoking may not exceed 2.5 ounces. Certification start date: MM/DD/YYYY Certification end date: MM/DD/YYYY”

How much smokable medical marijuana can be ordered/possessed at once?

Up to six 35-day supplies of smokable medical marijuana and may not exceed 2.5 ounces per 35-day order. Patients may only possess up to 4 ounces of medical marijuana in a form for smoking at any given time.

What are the documentation requirements for smokable medical marijuana?

1. A list of other routes of administration, if any, certified by a qualified physician that the patient has tried, the length of time the patient used such routes of administration, and an assessment of the effectives of those routes of administration in treating the qualified patient’s qualifying condition. 2. Research documenting the effectiveness of smoking as a route of administration to treat similarly situated patients with the same qualifying condition as the qualified patient. 3. A statement signed by the qualified physician documenting the qualified physician’s opinion that the benefits of smoking marijuana for medical use outweigh the risks for the qualified patient.

Where can the documentation forms be found?

Here: http://flhealthsource.gov/mum/forms

How often must a patient be seen by a doctor for smokable medical marijuana?

At least once every 30 weeks.

What will be evaluated?

Determine if the patient still meets the requirements to be issued a physician certification; and Identify and document in the qualified patient’s medical records whether there either of the following have been experienced: -A. An adverse drug interaction with any prescription or nonprescription medication; or -B. A reduction in the use of, or dependence on, other types of controlled substances.

Will a medical marijuana license show up on a background check?

No, the status of your medical marijuana usage is medically protected personal information, HIPAA. The existence of the state issued card is not technically HIPAA protected but state officials are not allowed to access or disclose the information without authorization and personal information like your social security number is not attached. Dispensaries can only see if your card is current and valid or not.

To renew, the patient or the caregiver must submit the renewal application plus any other needed documentation to the State at least 45 days before it expires. You can submit the application by mail or online.

Contact Information

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